Expectant management of miscarriage

Expectant management of miscarriage

Expectant management allows spontaneous passage of retained products of conception without any interventions (1).

It can be offered to selected patients with a confirmed first trimester miscarriage (2).

Expectant management is particularly successful in incomplete miscarriage when compared to other types of miscarriages. According to a review based on multiple cohort studies, expectant management was successful within 2-6 weeks without increasing complications in:

• 80-90% of women with incomplete spontaneous miscarriage
• 65-75% of women with delayed miscarriage or an empty sac (3).

Patients undergoing expectant management should be ready to have surgical evacuation in case of failed conservative management.

NICE state:

Use expectant management for 7 to 14 days as the first-line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if:

• the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or
• she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or
• she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have a blood transfusion) or
• there is evidence of infection

Medical management should be offered to women with a confirmed diagnosis of miscarriage if expectant management is not acceptable to the woman.

Offer a repeat scan if after the period of expectant management, the bleeding and pain:

• have not started (suggesting that the process of miscarriage has not begun) or
• are persisting and/or increasing (suggesting incomplete miscarriage)

Review the condition of a woman who opts for continued expectant management of miscarriage at a minimum of 14 days after the first follow-up appointment

For detailed guidance then see full guideline (4).

Reference:

• 1. Trinder J et al. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ 2006;332:1235-1240
• 2. Royal College of Obstetricians and Gynaecologists (RCOG) 2006. The management of early pregnancy loss
• 3. Sagili H, Divers M. Modern management of miscarriage. The Obstetrician & Gynaecologist 2007;9:2:102-108
• 4 NICE (September 2023).Ectopic pregnancy and miscarriage: diagnosis and initial management